Colorado Health Insurance

I'm looking for some advice on insurance here in Colorado. Here's my situation: Starting a new job where they don't provide group health coverage, but instead do provide $6000/yr toward whatever medical needs you have (I.e.: I believe it's an HRA or something like that).

At any rate, this means we need to get individual coverage. My wife and I are 28 and 27 respectively, healthy, non-smokers. We have an 18 month old. He was in the NICU for about 7 days which is another factor here. We have a desire to have more kids in the future. We currently have an HSA with Anthem BCBC which we are happy with, but they don't have the option of maternity.

As I've looked around I've seen very few good options for health insurance with maternity coverage. The only thing I've found is Assurant, but I've read some very mixed reviews about them online.

Here are my questions:
1. Is Assurant with maternity a good option? Does it make sense to do that? It seems expensive and has a separate deductible.
2. Are there any other options?
3. If we can't get Maternity, at least we would like to make sure a future newborn is covered if he/she has to be in the NICU. Do you know what this would look like?

Thanks for your help!

-- Edited by Lynne Erickson on Saturday 19th of September 2009 01:07:38 PM

Hello,

You have a unique situation.  There are some Colorado Laws in place that should protect your right to have maternity coverage under your "group" benefit plan.  , Scott Erickson, our group benefits specialist, will be commenting soon about a specific law that requires all "group" benefit plans to include coverage for maternity. This law may make your employer liable for your maternity expenses should your wife become pregnant while your employer is paying for your health insurance indirectly via an HRA, even if the healthplan you chose does not have maternity coverage.  This is a gray area in the law that leaves employers with a potential for a lawsuit against them by choosing to pay for employee's individual health insurance indirectly via an HRA instead of offering group health insurance to his/her employees.  Again, I have asked Scott to post specific details about this when he gets a chance.   We often warn our clients about this specific situation when advising them about setting up HRAs.  Scott is very adament against using HRAs for the purpose of funding premiums for employees to use for their own personal insurance just because of this specific kind of situation!

But, to answer your question about Assurant Health...Assurant Health, in my opinion, provides the best maternity coverage option available within the personal health insurance market in the State of Colorado.  You might consider combining the One Deductible HSA Compatible plan with a maternity option, so that you can save money in a tax-deductible HSA account to plan for future, out of pocket, maternity expenses.  The average childbirth costs approx. 10-12K.  You could combine the One Deductible plan with a $5K deductible maternity plan.  The 5K deductible maternity plan only costs approx. $15/mo.  Once the plan is in effect, open a health savings account (HSA) so you can save money on a tax-deductible basis, over time, to pay for the $5k deductible on the maternity plan.  The insurance will pick up the rest of the cost.  That way, at least you are paying for your 5K deductible with tax-advantaged $$.  When you purchase any of the Assurant Health Maternity riders, you will have access to network discounted rates for prenatal, labor and delivery care.  Without adding the maternity option (any deductible) you lose the advantage of the network discounts that Assurant Health has already negotiated with OBGYN and labor and delivery providers. 

In the state of Colorado, your newborn baby is automatically covered, without any medical underwriting, at birth, IF you add the child to your existing healthplan within 30 days of birth, so you wouldn't have to worry about healthcare costs related to an unhealthy newborn if you did not have maternity coverage.   Your existing Blue Cross plan would have to accept your new baby, regardless of health status at the time of birth provided you contact the insurance company to add the baby within 30 days after it is born.   



-- Edited by Lynne Erickson on Wednesday 1st of July 2009 07:54:25 AM

Interestingly, the Colorado Division of Insurance, just today, released a bulletin to describe their stance on the use of health reimbursement arrangements to allow employees to purchase their own health insurance within the scope of a "small group" benefit plan.

Here is a link to the bulletin:
http://www.dora.state.co.us/insurance/regs/B-4.32.pdf

According to this bulletin, the "establishment of an HRA and its use by any employee to pay or be reimbursed for health benefit plan premiums shall make such plan a small group plan for purposes of Colorado law and may subject the employer to tax or other liability".

Wow. We have been waiting for the division of insurance to take a stance on this issue for quite some time! What this is saying is that any individual health plan purchased with HRA dollars must comply with all Colorado Law that pertains to small group health plans. This would include the Mandatory Coverage Provisions, which stipulate that all Colorado Small Group Health Plans must include coverage for maternity.

What does this mean?  Well, if you purchased an individual health insurance plan with HRA dollars given to you by your employer, and you work in an establishment with fewer than 50 employees, and you purchased a plan that doesn't have maternity coverage, your employer may be liable for your or your dependent's maternity expenses, since by law, the employer benefit plan MUST include coverage for maternity.

It could also mean that if you have an exclusion of coverage for a specific disease on your healthplan, you employer may also be liable for coverage of that disease, since all Colorado Small Group Health Plans must be offered on a "guarantee issue" basis, and are subject to Colorado Statute 10-16-105.

-- Edited by Lynne Erickson on Wednesday 24th of June 2009 05:45:51 PM

-- Edited by Lynne Erickson on Wednesday 1st of July 2009 07:56:54 AM